The death of the “do or die” GOP health care plan, as the bill was pulled from a floor vote in the House on March 24, 2017, comes as no surprise. It was a non-coherent bill that depended entirely on votes from a large Republican majority in the House, but exposed bitter divisions between the hard-right Freedom caucus and more moderate Republicans. Despite the addition of many late amendments intended to address the concerns of the opposing groups, they often lost as many votes as were gained. This became a momentous defeat for the House Speaker Paul Ryan, President Donald Trump, and the Republican Party on what was intended to be its signature and opening domestic success.

Despite the Republicans having had seven years to develop their own health care plan, the American Health Care Act (AHCA) was a hastily drafted assemblage of ideas, largely based on Paul Ryan’s 37-page white paper in 2016, Better Way, and the proposed Empowering Patients First Act by Dr. Tom Price, now the Secretary of Health and Human Services. As a replacement for a repealed Affordable Care Act (ACA) (1), the plan would have done away with the individual mandate, promoted a free market approach, deregulated the private health insurance industry, eliminated the ACA’s requirement for coverage of essential services, added tax credits and given insurers wide latitude to charge older enrollees higher prices, fully repeal Medicaid expansion, and cut back women’s health care. Their longer-term goal was to privatize both Medicare and Medicaid.

Unfortunately and predictably, the debate in the media was superficially covered, disinformation and false promises were common, and legislators at the end did not know what was actually in the bill. As Republicans retreated from the issue, they were unpersuasive as to what they would do next. One day after the defeat of the repeal and replace bill in the House, President Trump declared  that “Obamacare will explode. We will all get together and piece together a plan for all the American people. Do not worry.” (Oval office statement, March 24, 2017). Meanwhile, leading Democrats hailed this event as a victory for saving the ACA and assurance of ongoing coverage for many millions of Americans.

Both the Republicans and Democrats were right in some respects. Democrats could take credit for the ACA’s many achievements, including 24 million people who gained insurance coverage, expansion of Medicaid in 31 states, increased funding of community health centers, banning insurers from denying coverage based on pre-existing conditions, and allowing children to remain on their parents’ coverage until age 26. On the other hand, Republicans could correctly say that the ACA did not bring cost containment, that insurance premiums have become increasingly unaffordable even as deductibles have soared, and that the ACA in the long run will not be sustainable.

But both major political parties are wrong in their current assessments of the situation. Democrats fail to acknowledge that the ACA will never bring universal coverage, that 28 million people are still uninsured seven years after the ACA’s passage, that underinsurance has become epidemic, that premiums have steadily increased for less coverage, that insurance markets have seen increased churning as patients lose choice and as networks narrow, and that more insurers are leaving the market in search of higher profits.

Meanwhile, Republicans still think that the only solution is deregulation of an unfettered private marketplace, expansion of health savings accounts, establishing more high risk pools, selling insurance across state lines, giving more responsibility for health care to the states with block grants, and further privatization of Medicare and Medicaid. None of these are new ideas, and all have proven to be more a problem than a solution.

What can we learn from the recent political dynamics of the failed GOP bill? Several conclusions stand out:

This is the landscape that the nation faces today, despite significant progress under the ACA: (5)

  • The average cost for insurance and care now exceeds $25,000 a yea for a family of four while the median household income for such a family is about $53,000.
  • 19 states never expanded Medicaid.
  • Signups for ACA coverage have fallen far short of expectations.
  • The insurance industry still has many ways to avoid sicker patients and maximize their profits.
  • Insurance directories are frequently inaccurate in terms of physicians and hospitals in their networks.
  • Many physicians refuse to see patients on Medicaid, while waiting times can be lengthy even if physicians do agree to see them.

So where can we go from here? Since the plans being offered by both political parties can never bring universal access with cost containment, we need to confront a major cause of the cost and access problem—an inefficient multi-payer financing system that puts profits above service, as  providers do with wide latitude to set their own prices. We need to mobilize grassroots support at local, state, regional and national levels for a real health care reform—single-payer national health insurance (NHI) based on an ethic of service that will immediately assure universal access to all Americans at costs that are affordable for patients, families, and taxpayers. This is not socialism since it will be tied to a private delivery system, within which providers will be adequately compensated through negotiated fees and prices of drugs and medical devices. We know that much of today’s bureaucracy will be eliminated and that we will save about $616 billion a year as soon as it is implemented ($503 billion by eliminating administrative overhead and $113 billion on outpatient prescription drugs). (6)

Towards this goal, advocates for NHI, or The Expanded and Improved Medicare for All Act (H.R. 676) will be organizing press conferences, rallies, die-ins and other events  on April 8, 2017 all across the country. In this effort at this moment for progressive change with bipartisan support, these words by Frances Perkins as she accepted President Franklin Roosevelt’s appointment as Secretary of Labor in 1933, serve as useful guideposts in today’s challenging times:

The people are what matter to government, and a government should aim to give all the people under its jurisdiction the best possible life. (Her Life: The Woman Behind the New Deal. Frances Perkins Center.

John Geyman, M.D. is the author of  The Human Face of ObamaCare: Promises vs. Reality and What Comes Next and How Obamacare is Unsustainable: Why We Need a Single-Payer Solution For All Americans



(1) (Geyman, JP. Crisis in U.S. Health Care: Corporate Power vs. The Common Good, Friday Harbor, WA. Copernicus Healthcare, 2017, p. 322).

(2) (Firozi, P. Poll: Just 17 percent of voters back Obamacare repeal plan. The Hill, March 23, 2017).

(3) (Facebook page of Lawrence O’Donnell, March 25, 2017).

(4) (Sanger-Katz, M. Late GOP proposal could mean plans that cover aromatherapy but not chemotherapy. New York Times, March 13, 2017).

(5) (Geyman, JP. Ibid Crisis book, pp. 258-276)

(6) (Woolhandler, S, Himmelstein, DU. Single-payer reform: The only way to fulfill the President’s pledge of more coverage, better benefits, and lower costs. Annals of Internal Medicine online, February 21, 2017).